ESTRO 36 Abstract Book

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S296 ESTRO 36 2017
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New roles in advanced practice for RTTs In a dynamic
field such as radiotherapy it is essential that all
professionals are equipped to assume evolving roles and
responsibilities that reflect changing practice. From a
professional and clinical perspective the RTT, as an
autonomous member of the team, must take equal
responsibility for the introduction of change in their
working environment. To enable this the ESTRO RTT
committee have produced the ESTRO RTT Education
Qualification Framework (EQF) for level 7 and 8. This has
identified a number of key areas where advanced roles
and responsibilities taken by RTTs will effectively support
the dynamic clinical changes in radiotherapy preparation
and delivery. On a professional level 7 and 8 will support
the development of research options for practice
improvement placing the RTT on an equal platform with
their professional colleagues. Links to the underpinning
academic topics to facilitate the development of these
roles have been made. Linking academic content and
evolving roles and responsibilities enables the RTT to take
his/her place as an equal member of the team by providing
the appropriate knowledge and skills that enable critical
evaluation of practice. Defining academic components at
level 7 and 8 provides a framework for staged role
development combining academic components with
clinical experience. The descriptions of level 7 and 8
within the ESTRO EQF are consistent with the level
descriptors defined in the European Qualifications
Framework. Level 7 is described as “highly specialized
knowledge, some of which is at the forefront of knowledge
in a field of work or study, as the basis for original thinking
and/or research …. a critical awareness of knowledge
issues in a field and at the interface between different
fields”[1]. Level 8 is described as ‘knowledge at the most
advanced frontier of a field of work or study and the
interface between fields’ providing the skills and
competences of “the most advanced and specialist skills
and techniques, including synthesis and evaluation,
required to solve critical problems in research and/or
innovation and to extend and redefine existing knowledge
or professional practice”[2]. The advanced roles include
treatment planning, patient support, management and
research amongst others. RTTs across Europe have
already embraced many of the advanced roles and
responsibilities and by providing this framework it is hoped
to provide a roadmap for others to follow suit. [1]
[2] Ibid
Symposium: Radiotherapy in the elderly
SP-0561 Radiotherapy in elderly rectal cancer
patients
R. Nout1
1 Leiden University Medical Center LUMC, Department of
Radiotherapy, Leiden, The Netherlands
The incidence of rectal cancer is increasing in elderly
patients due to effects of population screening and aging.
Total mesorectal excision (TME) surgery with or without
pre-operative radio(chemo)therapy is the standard
treatment for rectal cancer. However, with increasing age
and co-morbidity the risk of surgical complications and
post-operative mortality rises. In patients older than 75
years, and especially above 80, postoperative
complications occur in approximately 50% and
postoperative mortality is increased. In these situations,
the risks of postoperative complications and mortality may
render patients unfit for surgery. For the same reasons
these patients are usually also unfit for chemotherapy,
and often they are offered palliative radiotherapy.
Although palliative radiotherapy is effective in symptom
reduction in most patients, the duration of benefit is
limited. Importantly, there are situations that patients
might benefit from a more radical approach using
radiotherapy alone, with the aim to provide durable local
control. With standard external beam
(chemo)radiotherapy (EBRT, 45-50 Gy), complete
pathologic response (pCR) is reached in approximately
16%. But dose response analyses indicate that a high dose
of more than 90Gy (EQD2) is needed to achieve pCR in 50%
of patients. EBRT with either contact-X-ray or endorectal
high-dose-rate brachytherapy have been used in these
situations. Outcomes of these approaches for local control
and toxicity will be reviewed followed by an update of
ongoing studies.
SP-0562 Breast cancer
I. Kunkler1
1Western General Hospital- Edinburgh Cancer Centre,
Edinburgh, United Kingdom
The evidence base for postoperative radiotherapy after
mastectomy and after breast conserving surgery (BCS) and
for accelerated partial breast irradiation (ABPI) is limited
in older patients. This reflects in part historical exclusion
of patients >70 years from many trials or trials which
included but were not confined to older patients. The
Oxford overview (1) shows that postmastectomy
radiotherapy (PMRT) reduces local recurrence and breast
cancer mortality in women with 1-3 positive nodes as well
as 4 or more positive nodes. However the role of PMRT in
women with 1-3 involved nodes remains controversial. The
current MRC/EORTC SUPREMO trial and its translational
substudy TRANS-SUPREMO (2) is addressing this issue and
has no upper age limit. There is a need to refine the
selection of patients for PMRT on a biological basis with
the aid of molecular markers (3). There is consensus that
shorter, hypofractionated schedules of whole breast RT
(WBRT) in 15 or 16 fractions are appropriate for older
patients. Recent 20 year follow up of the EORTC ‘boost’
trial shows no statistically significant advantage in local
control from the addition of a 16 Gy boost to the site of
excision after WBRT (4) in women over the age of 60.
There is a developing level 1 evidence base to suggest that
omitting postoperative WBRT in ‘low risk’ older patients
after BCS is an option but the issue remains controversial.
The CALGB 9343 trial in T1,NO women =/>70 yrs showed a
3% reduction in loco-regional recurrence at 5 years (1% vs
4%) and 7% at 10.5 years (2% vs 9%)[5,6]. However, while
the early results changed NCCN guidelines to allow the
omission of WBRT in patients meeting the eligibility for
the CALBG trial, international practice has not changed
substantially with WBRT remaining standard, irrespective
of risk category. The recent PRIME 11 trial in a higher risk
of group of patients =/>65 years (T1-2 [up to 3cm],NO)
showed a modest but statistically significant reduction in
ipsilateral breast tumour recurrence from WBRT after BCS
at a median follow up of 5 years (1.3% vs 4.1%) [7].
Whether this difference is sufficiently small to change
practice remains to be seen. Current studies such as
PRIME-TIME (8) in the UK and PRECISION (9) in the US focus
on assessing the role of biomarkers to refine the selection
of ‘low risk’ patients for omission of postoperative
radiotherapy after BCS in older patients. None of the four
published trials on ABPI to date, using a variety of
techniques (brachytherapy, external beam,intraoperative
irradiation) were confined to older patients, allowing
limited conclusions in this age group.
1. EBCTCG. Effect of radiotherapy after mastectomy and
axillary surgery on 10 year recurrence and 20 year breast
cancer mortality: meta-analysis of individual patient data
for 8135 women in 22 randomised trials. Lancet
2014;383:2127-35.
2. Kunkler IH, Canney P, van Tienhoven G et al.
MRC/EORTC (BIG 2-4) SUPREMO trial management group.
Elucidating the role of chest wall irradiation in